Risk Factors Associated with Perinatal Relapse to Opioid Use Disorder.

The recent opioid epidemic in the United States has led to rising prevalence of maternal opioid use disorder (OUD). First-line treatment for maternal OUD involves the use of opioid agonist pharmacotherapy, such as methadone or buprenorphine, in addition to cognitive behavioral therapy and counseling. The management of maternal OUD can become overwhelming for both patients and clinicians, especially during the early postpartum period. Therefore, it is imperative that clinicians understand the impact of additional stressors in caring for these patients. Maternal chronic opioid dependence can lead to neonatal opioid withdrawal syndrome after birth. This multisystem condition affects neonatal neurobehavioral functioning and has significant human and socioeconomic consequences. First-line treatment for this syndrome involves intensive nonpharmacologic comforting measures, with maternal presence and involvement being central to ensuring the success of such measures. In this review, we describe the factors that place pregnant and postpartum women with OUD at risk of returning to illicit opioid use. We evaluate these multifaceted personal, social, societal, and systemic factors to inform the development of future clinical care initiatives.

Border Crosser Deaths in the Arizona-Mexico Desert: Data on Remains 2001-2020.

INTRODUCTION: Increased enforcement at U.S.-Mexico border-crossing sites may lead migrants to cross in remote desert areas. METHODS: We reviewed data on migrants' bodies found along the Arizona-Mexico border from 2001 to 2020. We analyzed causes of death, condition of bodies, age, and sex, and the relationship of deaths to enforcement (arrests) by U.S. Border Patrol. RESULTS: From 2001-2020, 3,378 border-crosser bodies were found in the desert. As enforcement increased, bodies were found in more remote areas and later stages of decomposition. Skeletonized bodies increased from 19% in 2001-2004 to 49.1% in 2017-2020. When the cause of death could be identified, exposure to the elements was the most common cause. Abrupt increases in arrests and deaths over the immediately preceding period of 2013-2016 occurred in 2017-2020. CONCLUSIONS: Undetermined cause of death and increased skeletonization became more common, indicating bodies are discovered later. Enforcement does not decrease individuals crossing the border; rather, individuals cross in more remote areas.